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Healthcare Professionals Get a Copay Card
Graphic of healthcare professional talking to two patients Graphic of healthcare professional talking to two patients Graphic of healthcare professional talking to two patients
Healthcare Professionals Get a Copay Card

Our mission at IncyteCARES for OPZELURA is to help eligible patients access and afford their prescribed Incyte medication.
Our team is available to Healthcare Professionals and patients Monday through Friday, 8 AM–8 PM ET.

Financial Assistance Options

copay card

Eligible patients may pay as little as $10* per tube.

To qualify, patients must:

  • Have commercial prescription drug coverage. Patients insured under federal or state government prescription drug programs—including Medicare Part D, Medicare Advantage, Medicaid, or TRICARE—are not eligible. Patients without prescription drug coverage are also not eligible
  • Be a resident of the United States or Puerto Rico
  • Have a valid prescription for OPZELURA for an FDA-approved use

*Eligibility required. Individual savings limited to $2,076.50/tube, $10,000 per year. For use only with commercial insurance. The card may not be used if you are enrolled in a government-funded prescription insurance program or if you pay cash for your prescription. Must be used for an FDA-approved indication. Additional Terms and Conditions apply.

Get a Copay Card

Activation Required: Your patient's eligibility for the card will be assessed by 4 questions. Following activation, you can then download and print or email the card.

Other options for getting copay cards for your patients include:

  • Call your representative to have copay brochures delivered to your office
  • Tell your patient to visit OPZELURA.com/copay-program to get a card via download, text, or email
  • Tell your patient to call IncyteCARES for OPZELURA to request a card over the phone

Eligible patients can receive medication free of charge

Patients who are uninsured or underinsured may be eligible for free OPZELURA from Incyte.

To qualify, patients must:

  • Be confirmed as eligible and enrolled in IncyteCARES for OPZELURA
  • Be a resident of the United States or Puerto Rico
  • Have a valid prescription for OPZELURA for an FDA-approved use
  • Patient’s adjusted annual household income must be less than or equal to 400% Federal Poverty Level (FPL)

    2021 Income Levels Associated With IncyteCARES for OPZELURA Based on 400% FPL

Household Size
Total Pre-tax Annual Income
$51,520
$69,680
$87,840
$106,000
$124,160

If the patient lives in Alaska or Hawaii or has a household with more than 5 members, please call 1-800-932-1720. Income levels are subject to change on an annual basis; current levels reflect the 2021 Federal Poverty Level Guidelines.

  • Additional eligibility criteria depend on your insurance type:
  • Uninsured
    • Patient is uninsured or has medical insurance but no coverage for their prescription medications
    Medicare Part D, Underinsured
    • Patient is enrolled in a Medicare Part D prescription insurance plan and has expressed and documented an inability to afford their out-of-pocket cost
    • Patient must not be a beneficiary of any of these government insurance or healthcare programs including, but not limited to: Medicaid, Medicare Part D Low-Income Subsidy (LIS) program, Veterans Affairs (VA), the Department of Defense (DoD), TriCare, or any State Patient Assistance Program (SPAP)
    • Patient must pass a means test that proves total out-of-pocket prescription costs exceed 10% of household income

How to Apply

Download Form

Complete and fax the IncyteCARES for OPZELURA Prescription and Enrollment Form.

For timely processing, be sure to:

  • Include number of tubes, refills, and ICD-10 codes in section 2, Prescription for OPZELURA
  • Sign sections 2 and 3
  • Have patients complete and sign sections 4 through 9
    • Note: Proof of income must be provided. Income can be verified electronically if the patient completes and signs section 8. Alternatively, documentation can be faxed. This can be the patient’s latest Form 1040, W-2 statement, Social Security letter, or month’s worth of pay stubs
  • Provide a copy of the Privacy Notice on page 4 to the patient

What Happens Next

Number one

We Review the Application

Our team confirms lack of coverage and determines if the patient meets program eligibility requirements.

Number two

We Communicate the Outcome

  • Our team will inform both you and your patient of the outcome of the patient’s application
  • If approved, the patient will need to reapply each calendar year to continue to receive free goods
  • If denied, the patient may appeal the decision
Number three

We Triage Prescription to Patient Assistance Program (PAP) Program Pharmacy

If approved, patient’s prescription for OPZELURA will be filled and shipped by our designated PAP pharmacy to the address they provide.

Note: If patient’s insurance coverage or financial status changes in the interim, you or your patient should contact IncyteCARES for OPZELURA to update the patient’s profile.

Terms and conditions apply. Terms of this program may change at any time.

Forms

IncyteCARES for
OPZELURA
Prescription and
Enrollment Form

Download Form


Sample Letter
of Medical Necessity

Download Form

Sample Letter of Appeal

Download Form

Contact Us

Call the IncyteCARES for OPZELURA phone center for Healthcare Professionals
at 1-800-932-1720, Monday through Friday, 8 AM–8 PM ET

INDICATION AND USAGE

OPZELURA is indicated for the topical short-term and non-continuous chronic treatment of mild to moderate atopic dermatitis in non-immunocompromised patients 12 years of age and older whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable.

Limitation of Use:

Use of OPZELURA in combination with therapeutic biologics, other JAK inhibitors or potent immunosuppressants such as azathioprine or cyclosporine is not recommended.

IMPORTANT SAFETY INFORMATION

SERIOUS INFECTIONS

Patients treated with oral Janus kinase inhibitors for inflammatory conditions are at risk for developing serious infections that may lead to hospitalization or death. Reported infections include:

  • Active tuberculosis, which may present with pulmonary or extrapulmonary disease.
  • Invasive fungal infections, including candidiasis and pneumocystosis.
  • Bacterial, viral, and other infections due to opportunistic pathogens.

Avoid use of OPZELURA in patients with an active, serious infection, including localized infections. If a serious infection develops, interrupt OPZELURA until the infection is controlled. Carefully consider the benefits and risks of treatment prior to initiating OPZELURA in patients with chronic or recurrent infection. Closely monitor patients for the development of signs and symptoms of infection during and after treatment with OPZELURA.

No cases of active tuberculosis (TB) were reported in clinical trials with OPZELURA. Cases of active TB were reported in clinical trials of oral Janus kinase inhibitors used to treat inflammatory conditions. Consider evaluating patients for latent and active TB infection prior to administration of OPZELURA. During OPZELURA use, monitor patients for the development of signs and symptoms of TB.

Viral reactivation, including cases of herpes virus reactivation (e.g., herpes zoster), were reported in clinical trials with Janus kinase inhibitors used to treat inflammatory conditions including OPZELURA. If a patient develops herpes zoster, consider interrupting OPZELURA treatment until the episode resolves.

Hepatitis B viral load (HBV-DNA titer) increases, with or without associated elevations in alanine aminotransferase and aspartate aminotransferase, have been reported in patients with chronic HBV infections taking oral ruxolitinib. OPZELURA initiation is not recommended in patients with active hepatitis B or hepatitis C.

MORTALITY

Higher rate of all-cause mortality, including sudden cardiovascular death, has been observed in patients treated with oral Janus kinase inhibitors for inflammatory conditions.

MALIGNANCIES

Lymphoma and other malignancies have been observed in patients treated with Janus kinase inhibitors for inflammatory conditions. Patients who are current or past smokers are at additional increased risk. Non-melanoma skin cancers, including basal cell and squamous cell carcinoma, have occurred in patients treated with OPZELURA. Perform periodic skin examinations during OPZELURA treatment and following treatment as appropriate.

MAJOR ADVERSE CARDIOVASCULAR EVENTS (MACE)

Higher rate of MACE (including cardiovascular death, myocardial infarction, and stroke) has been observed in patients treated with Janus kinase inhibitors for inflammatory conditions. Consider the benefits and risks for the individual patient prior to initiating or continuing therapy with OPZELURA, particularly in patients who are current or past smokers and patients with other cardiovascular risk factors. Patients should be informed about the symptoms of serious cardiovascular events and the steps to take if these symptoms occur.

THROMBOSIS

Thrombosis, including deep venous thrombosis, pulmonary embolism, and arterial thrombosis has been observed in patients treated with oral Janus kinase inhibitors for inflammatory conditions. Many of these adverse reactions were serious and some resulted in death. Patients with symptoms of thrombosis should be promptly evaluated.

Thromboembolic events were observed in clinical trials with OPZELURA. There was no clear relationship between platelet count elevations and thrombotic events. OPZELURA should be used with caution in patients who may be at increased risk of thrombosis.

Thrombocytopenia, Anemia and Neutropenia

Thrombocytopenia, anemia and neutropenia were reported in the clinical trials with OPZELURA. Consider the benefits and risks for individual patients who have a known history of these events prior to initiating therapy with OPZELURA. Perform CBC monitoring as clinically indicated. If signs and/or symptoms of clinically significant thrombocytopenia, anemia, and neutropenia occur, patients should discontinue OPZELURA.

Lipid Elevations

Treatment with oral ruxolitinib has been associated with increases in lipid parameters including total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides.

Adverse Reactions

The most common adverse reactions (≥1%) are nasopharyngitis (3%), diarrhea (1%), bronchitis (1%), ear infection (1%), eosinophil count increased (1%), urticaria (1%), folliculitis (1%), tonsillitis (1%), and rhinorrhea (1%).

Pregnancy

There will be a pregnancy registry that monitors pregnancy outcomes in pregnant persons exposed to OPZELURA during pregnancy. Pregnant persons exposed to OPZELURA and healthcare providers should report OPZELURA exposure by calling 855-4MEDINFO or 855-463-3463.

Lactation

Advise women not to breastfeed during treatment with OPZELURA and for four weeks after the last dose (approximately 5 elimination half-lives).

Please see the Full Prescribing Information and Medication Guide.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

You may also report side effects to Incyte Medical Information at 1-855-463-3463.